The effect of acquired brain dysfunction on visuomotor integration in neonatal critically ill children

Critically ill new-born babies can in the long term develop mental and/or motor
problems, even when they are born at term. Recently, it has been shown that
when these children reach school age, they often have problems with ball
skills. It seems that these children have acquired some form of brain
dysfunction due to critical illness, treatment in intensive care, and the need
for surgical interventions in the first phase of life. Based on currently
available literature on long-term outcomes after neonatal critical illness, our
hypothesis is that the acquired brain dysfunction has led to problems with the
translation of visual information (e.g. determining the position and speed of
the ball) into a goal-directed motor action (i.e. a coordinated eye-hand
movement for catching the ball). This process in the brain is termed visuomotor
integration (VMI).

Do neonatal critically ill children aged 9-16 years have problems with
visuomotor integration? If yes, which aspects of the visuomotor integration are
affected and require a possible intervention?

observational study with participants and controls

There are recent techniques available to quantitatively assess visuomotor
integration. These new techniques offer the possibility to test the efficiency
of performing different aspects of catching a ball. However, good norm values
for children are not yet available for some specific tasks. For this reason, it
is important not only to examine the patients but also healthy controls. For
interpretation of the research results, vision is included as a confounding
factor. A refractive error or reduced binocular vision - caused by a
developmental disorder - can lead to a blurred image or a delayed perception of
an image. From our own experiences, children like the neuropsychological, motor
and eyetracking tests, but it requires to some extend some effort of the
investigators to keep them focussed.
Burden consists of research time (including travelling time this may take one
full working day for both children and parents), filling in questionnaires by
the parents (can be done while waiting for a next test session), and the use of
eye drops prior to the diagnostic ophthalmological examination. Administration
of the cycloplegium cyclopentolate 1% may be felt when the liquid is dripped in
the eyes and the children may have transient visual problems due to
accommodation problems (described at 1-10% according to the Pharmacotherapeutic
Compass). There is very little chance of developing an increased intraocular
pressure (described at 0.1-1% according to the Pharmacotherapeutic Compass).
The procedure of administering a cycloplegium is a routine procedure in
diagnostic eye examinations and will be carried out by expert personnel who
have experience with this type of procedure and the subsequent ophthalmological
examination in children. As a result, the burden will be minimal and outweigh
the possible benefits, namely insight into visuomotor integration, for which
specific intervention may be possible in due course. A standard intervention is
currently not available for this group of children, but if deviations are
identified during the study that can be improved with targeted intervention
(for example, ophthalmological abnormalities), the participant will be referred
for further treatment. In those cases, the participant benefits from
participating in the research.
It is of great importance for the current patient population but also for
children in other high-risk groups to study the quality of visuomotor
integration at a young age by means of specific eye-hand tasks. Restrictions in
this area may not only affect ball skills (and therefore success in leisure
activities and sports), but also have an impact on other situations in everyday
life that must be anticipated in a moving and changing environment. When the
problem is discovered at a young age, specific interventions or even
rehabilitation can be initiated early in life. This research may lead to the
development and evaluation of a targeted intervention that may help future
children at risk.